Page 24 - HME Business, March 2020
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“The biggest trend you are reporting is how
many claims are paying at the first pass. You want to be driving that number as close to 100 percent as possible.”
— Lisa Anderson, Universal Software Solutions
Your accounting folks are already managing profit and loss reports, sales figures, claims figures and other basic information. But it’s also likely that your system can do so much more.
“As we’ve evolved, we see that more clients want to get into the data themselves,” says Lisa Anderson, vice president of marketing at Universal Software Solutions. “Most standard DME systems are going to offer you standard reports. The ones that have been around for a long time have more — hundreds of standard reports — and you don’t have to pay extra for that.”
If you don’t know how to use the included features, your software support is just a phone call away. If the tools you have won’t answer your questions, most major vendors offer add-on modules for specific tasks and can custom- design reports for their clients. Costs will vary with complexity, but may be lower than you think. It’s worth asking.
It’s worth noting that pharmacists have become much more accustomed to fully elec- tronic systems — and their consequential instant authorizations — because of CMS pressure for physicians, facilities and pharmacies to adopt Electronic Health Records (EHR). The DME world lags in large part because there’s been no insti- tutional incentive or penalty — but that doesn’t mean there’s no benefit.
DME office software is built to let you enter information manually or receive it digitally, by fax or electronic ordering. Most software has built-in cues to make sure required fields are filled out when you enter an order, so you can be sure that instructions and authorizations are filed with the prescription. Those collateral items can be scanned and uploaded or transmitted
via an e-prescription system. The software’s billing capability should let you send the claim and documentation through to payers for prior authorizations and payment. (NOTE: If you’re a pharmacy, your software provider probably has an add-on DME module available.)
Automating your information unlocks a huge variety of reporting capabilities that can give
you real-time insights into how your business is running, often in a couple of keystrokes. Most current software includes dashboards to bring up information easily on a computer screen, as well as reporting capabilities to generate reports by advance scheduling or on-demand. You can pull reports on just about anything — referrals,
transactions, products, patients, labor, inventory, orders, claims — you name it.
For example, if you think placing and filling orders is taking too long, you can look up how long it’s taking and drill in by product to see
if any particular item or category is lagging, which might mean a supplier or inventory issue. You can check by payer, to see if a payer is rejecting certain orders like a particular item
or code. Or report by referral, to see if orders from some referrals are taking longer to fill than others — a sign that a source might not be sending all the required documentation with prescriptions.
With DME-specific software, “There is a simple dashboard, you can look at one screen and it will show you the top 10 physicians that are sending you referrals that have incomplete documenta- tion,” Anderson says. “It’s very clear what they need to do, and their office managers love that.”
GET IT RIGHT FROM THE START
If you think (RCM) starts with billing, you’re doing it wrong. Intake is where you take control of your patient records and documentation. The first goal is a clean claim, and that means perfect documentation. Manual, and especially analog, documentation is sooo last century, not least because it’s cumbersome and there are so many opportunities for errors. It’s probably easiest
to have one system that handles all your major business functions, but it’s essential for whatever systems you are running to talk to each other — to be interoperable.
“RCM really starts at intake. The referral sends you a fax with all the pertinent information, now you are creating an order within the system, you are populating the system with the order. You might have to schedule the delivery, and it shows you all the necessary information. You have to get a prior authorization from a payer; you are getting all that documentation together and all that pertinent information so now your claim is ready to send to the payer,” says Sunil Krishnan, vice president of RCM at Brightree. “Once it generates invoices, now it is generating revenue in your system. As an order, it is not revenue yet. The invoice becomes revenue.”
Intake is the parallel process of gathering information to get the best product fit for the patient, records to satisfy payers, and informa- tion that has its own value. Would the patient
rather be contacted by phone, text or email? Would they prefer pickup or delivery for future orders? Are they managing conditions other than what today’s prescription is for? Does the patient feel lost or unsupported about their condition(s)? Those bits of information may all be opportuni- ties for marketing and loyalty — more on that in a minute. First, a bit on getting paid.
STAKE YOUR CLAIMS
“We all know getting paid is one of the head- aches of the HME industry — reprocessing is labor-intensive and expensive. The right compli- ance-centric software helps providers avoid preventable errors, producing revenue-qualifying orders the first time,” Turner says.
Pharmacists have become accustomed to getting instant authorization for medications. DMEs have been used to a sometimes lengthy back-and-forth about what’s covered, who’s paying and how much. Good billing software gets right in there to speed those authorizations and your fill times.
“The biggest trend you are reporting is how many claims are paying at the first pass. You want to be driving that number as close to 100 percent as possible,” Anderson says, adding, “The 2 percent that still deny will take a ton of work.“ With electronic submissions, your claim goes
to a clearinghouse “Once it gets to the payer
and they process it, you are able to get approval electronically. It tells you, you will receive x dollars of cash and x dollars of adjustment. It tells what information you might be missing,” Krishnan says. “The clearinghouse will tell you if it will reject the claim or send it on to the payer. You are able to fix it and now it goes to the payer after the first check.”
The tools allow you to self-audit your business from beginning to end. Spotting problem trends and addressing them one at a time is the key to strengthening and building your business.
“Even if you’re only dealing with a small percent of claim denials, someone has to be watching the trends at all times. There is no profit margin once a claim rejects,” Anderson
22 HMEBusiness | March 2020 | hme-business.com
Management Solutions | Technology | Products
“Once the
patient has
had a great
experience,
hopefully that
becomes a
lifetime patient, or one
who will refer you to others.”
– Sunil Krishnan, Brightree LLC


































































































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